End-of-life care

Transfusions may benefit palliative care patients after all

Thursday, 15 Jun 2017

Red blood cell transfusions appear to offer relief from symptoms of anaemia in most palliative care patients however more work needs to be done to optimise the use of donor blood in this setting.

An international study of more than 100 patients found 78% of transfusions for symptoms such as fatigue, breathlessness, generalised weakness and dizziness led to improvements in at least one symptom.

As well, 49% of transfusions provided relief from the nominated primary target symptom, which was most commonly fatigue.

Patients with an Australia-modified Karnofsky Performance Scale (AKPS) score in the range 40-50 were the most likely to benefit from transfusion but no other predictors of response were identified.

Co-author Dr Timothy To from the Southern Adelaide Palliative Services and Flinders University, told the limbic the results were somewhat unexpected.

 “I came into this study with the bias that we probably give blood transfusions without much benefit. There is certainly a pressure on us to do something – from patients, carers and internally, from ourselves.”

He said earlier research in Adelaide – reported by the limbic here – had shown that while patients and clinicians reported subjective benefit from transfusions, there was little change in scale-based measures of physical function or symptoms.

However the current study, across 17 sites and 5 countries, suggested the benefits of transfusion outweighed the risks in most patients.

Harms identified in the study including fever, infusion-related reaction and infusion site extravasation were infrequent and mild.

“There is no evidence to say transfusions don’t make a difference but we need to be thoughtful about this and check for iron deficiency and other reversible causes,” Dr To said.

“We also need to assess the benefit to individual patients after each transfusion and if it doesn’t work, don’t repeat the process.”

He said the patients with mid-range AKPS scores who benefited most were quite compromised but not enough that their disease was overwhelming.

Future studies should consider using more objective measures of function and response to transfusions such as accelerometers.

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